A critical analysis of prophylactic medical examination of population was conducted for detecting early oncological pathology. Methodological approaches in the practice of selecting persons with pretumorous diseases were examined. Great emphasis was put on the necessity of ascertaining the rates of accelerating functional changes as the most characteristic and accessible sign of tissue change from normal into pathological. A diagram-inset for the case histories of ambulatory patients to be included into prospective programme of prophylactic medical examination is suggested.
Positron emission tomography/computed tomography (PET/CT) is a newer imaging modality that combines whole-body PET using [(18)F]fluorodeoxyglucose (FDG) and contrasted high-resolution CT. This has the advantage of combining the functional imaging of FDG-PET with the anatomic detail afforded by CT.
To assess the cost-benefit of whole-body PET/CT as a diagnostic tool in head and neck cancer.
A retrospective cohort (American Joint Committee on Cancer III-IVB squamous cell carcinoma in 2003) was reviewed for costs of diagnostic tests, distant metastases, and treatment type. This was compared to a hypothetical cohort of patients using PET/CT as a sole diagnostic tool using the current literature on test characteristics in the detection of distant metastases. The main outcome measure was the cost of the diagnostic workup, and the secondary outcome measure was the cost of the treatment.
The cost of the traditional workup was $450 per patient, whereas the cost of PET/CT workup was $722 per patient. The sensitivity of the traditional workup for lung metastases at 12 months was 14.3%. The average cost of curative surgery was $81,290, radiotherapy was $8,224, and chemotherapy was $1,158. In the cohort of 76 patients reviewed, improved PET/CT sensitivity would theoretically detect three more cases of metastatic disease and reduce the total cohort cost of treatment by $198,526 by relegating these patients to palliation.
PET/CT is a more expensive test when used alone in the diagnostic workup of head and neck cancer but results in an overall cost savings by reducing the number of futile radical treatments. There is a cost benefit to the use of PET/CT as the diagnostic and staging test for head and neck cancer patients.
Lung cancer is the leading cause of cancer morbidity and mortality. In addition, lung cancer has a significant economic impact on society.
To present an economic analysis of the actual care costs of lung cancer which will allow comparison with, and verification of, cost estimates that were developed through modelling and opinion.
A chart review was conducted of incident cases (circa 1998) of primary bronchogenic lung cancer. Cases were censored at two years from the date of diagnosis. Relevant clinical and health utilization data were collected. Health utilization data included hospital and institutional outpatient (ie, ambulatory clinic) costs. Cost estimates were derived for over 200 specific health services. The present analysis was performed from the economic perspective of the health care institution.
A total of 13,389 health service events were captured with an estimated total cost of $8.4 million. Laboratory tests, diagnostic imaging and ambulatory visits constituted 86% of the service events while patient admissions and therapy constituted 76% of the costs. The vast majority of overall costs occurred just before, or within, three months of diagnosis. The median nonsmall cell lung cancer and small cell lung cancer case costs were $10,928 (range $9,234 to $11,047) and $15,350 (range $13,033 to $21,436), respectively.
The results agree with the literature that the majority of lung cancer case costs are realized around the date of diagnosis (ie, early phase). The present study illustrates Canadian health care system lung cancer case costs based on actual care received versus hypothetical care algorithms.
Cites: Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1025-3311072159
The POpulation HEalth Model (POHEM) lung cancer microsimulation model has provided a useful framework for calculating the cost of managing individual cases of lung cancer in Canada by stage, cell type, and treatment modality, as well as the total economic burden of managing all cases of lung cancer diagnosed in Canada. These data allow an estimation of the overall cost effectiveness of lung cancer therapy. the model also provides a frame-work for evaluating the cost effectiveness of new therapeutic strategies, such as combined modality therapy for stage III disease or new chemotherapy drugs for stage IV disease. By expressing the cost of lung cancer treatment as cost of life-years gained, such analyses allows useful comparisons of the cost effectiveness of these treatments with those of other costly but accepted medical therapies.
Escalating health care costs have made it imperative to evaluate the resources required to diagnose and treat major illnesses in Canadians. For Canadian men, lung cancer is not only the most common malignancy, but also the major cancer killer. As of 1994, lung cancer is expected to overtake breast cancer as the leading cause of cancer deaths in women. This paper presents a detailed description of the methodology used to determine the direct health care costs associated with 'standard' diagnostic and therapeutic approaches for lung cancer in Canada in 1988. Clinical algorithms were developed for each stage of non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). The algorithms were designed to take the form of decision trees for each clinical stage of lung cancer. The proportion of patients assigned to each branch was based upon questionnaire responses obtained from thoracic surgeons and radiation oncologists when presented with clinical scenarios, and information from provincial cancer registries. Direct care costs were derived primarily from one provincial fee schedule (Ontario), and costing information obtained during the conduct of several Canadian clinical trials in lung cancer. Direct costs for diagnosis and initial treatment of NSCLC (excluding relapse and terminal care costs) ranged from $17,889 for the surgery/post-operative radiotherapy arm of stages I and II to $6,333 for the supportive care arm (stage IV). The cost of determining relapse for NSCLC was estimated to be $1,528, and terminal care costs, which included palliative radiotherapy and hospitalisation, were $10,331. Direct costs for diagnosis and initial treatment of SCLC ranged from $18,691 for limited stage disease to $4,739 for the supportive care arm of extensive disease. The cost of diagnosing relapse for SCLC was estimated to be $1,590, and terminal care costs averaged $9,966. This report provides an estimate of the Canadian costs of managing lung cancer by stage and treatment modality. Because the actual costs of all components of care are not available from any combination of sources, these cost estimates must be viewed as an idealised estimate of the cost of lung cancer management. However, we believe that the lung cancer costing model that we have developed provides a level of sophistication which gives a reasonable estimate of the cost per case of treating NSCLC and SCLC.
A critical review of some aspects of follow-up examinations and regular check-ups is provided. A criterion of medical and economic advisability of these examinations is suggested which would permit one to substantiate their regional variations and increase their effectiveness.
Because lung cancer is a major health care problem in Canada, it would be useful to identify the direct health care costs of diagnosing and treating this disease and to create an analytic framework within which diagnostic and therapeutic options can be assessed. This paper describes a method of modelling the costs of care for lung cancer. The perspective of the costing model is that of the government as payer in a universal health care system. Clinical algorithms were developed to describe the management of non-small cell (NSCLC) and small cell (SCLC) lung cancer. Patients were allocated to the treatment algorithms in the model, based on a knowledge of the stage distribution of cases within provincial cancer registries and an estimate of the use of therapeutic modalities, according to lung cancer experts. A microsimulation model (POHEM) developed at Statistics Canada was used to integrate data on risk factors, disease onset and progression, health care resource utilization and direct medical care costs. The model incorporates survival data on patients, according to cell type and stage, based on published studies. Relapse and terminal care costs were assigned during the year of death, in order to determine the cost of continuing care and the cumulative cost of lung cancer management over time. Patients surviving five years were assumed to be cured. The model estimates that the total five year cost to provide care to the 15,624 cases of lung cancer diagnosed in Canada in 1988 was in excess of $328 million. Over 82% of this total was spent in the first year for diagnostic tests, therapy (surgery, chemotherapy, radiation therapy, or combinations of these), hospitalization and follow-up costs. The average five year cost per case was $21,000, and ranged from a high of $29,860 for limited disease SCLC, to a low of $16,500 for Stage IV NSCLC. The actual cost of providing care, including the management of complications, is unknown and our estimates should be regarded as an idealized estimate of the cost of lung cancer management. However, the POHEM model has a level of sophistication which, we believe, reasonably reflects the cost per case and total costs of treating lung cancer by stage and therapeutic modality in Canada.